Candace Garcia
Brentwood,CA
Summary
Dedicated Patient Account Representative with expertise in HIPAA compliance, insurance verification, and effective relationship building. Proven ability to analyze billing reports and resolve discrepancies, ensuring accurate patient accounts .
Hardworking Patient Account Representative dedicated to customer service and patient care. Outgoing and flexible team player. Talent for developing creative solutions that satisfy all parties.
Overview
10
10
years of professional experience
Work History
Patient Account Representative II
Stanford Health Care
Remote- CA
12.2017 - Current
- Manage patient accounts, ensuring accuracy in billing and insurance verification processes.
- Analyzed billing reports to identify trends and areas for improvement within patient account operations.
- Reviewed insurance eligibility and verified coverage details to minimize claim denials and delays in payment.
- Utilized computer programs to create invoices, letters, and other documents.
- Coordinated communication between patients, insurance providers, and healthcare teams to resolve account discrepancies.
- Payer clerical and technical denial review and request processing including basic appeals
- Following up on unresolved patient accounts in Epic by contacting the payer by phone or via the
portal - Reviewing and resolving payer rejections, denials, and performing appeals as necessary
- Completing basic charge corrections
- Responding to requests from the payer, such as providing medical records or other
documentation either by mail or via payer portals - Following up on unresolved patient accounts in Epic by contacting the payer by phone or via the
portal - Resolving claim edits
Insurance Follow Up Analyst
University Healthcare Alliance
Newark, CA
08.2016 - 12.2017
- Analyzed healthcare data to identify trends and improve patient outcomes.
- Performs analysis on accounts on a daily basis taking appropriate action(s) as needed to maximize collection potential
from payers. - Researches payer issues and/or policies and negotiates with payer representatives for positive resolution on complex
claims scenarios - Initiates the appeals process when warranted.
- Performs other duties and works on special projects as assigned.
- Communicates payer trends to manager in a timely manner.
- Maintains a level of professionalism that is a reflection of UHA and the C-I-CARE initiative.
- Responding to requests from the payer, such as providing medical records or other
documentation either by mail or via payer portals - Completing basic charge corrections
- Following up on unresolved patient accounts in Epic by contacting the payer by phone or via the
portal - Resolving claim edits
- Reviewing and resolving payer rejections, denials, and performing appeals as necessary
- Electronic or hardcopy claims editing and submission to payers
Education
Medical Assisting
Heald College
CA04-2010
High School Diploma -
Ceres High School
Ceres, CA06-2002
Skills
- HIPAA compliance
- Insurance verification
- Insurance billing
- Medical billing
- Follow-up skills
- Decision-making
- Relationship building
- Microsoft office
- Teamwork
- Teamwork and collaboration
- Flexible and adaptable
- Multitasking Abilities
- Reliability
Timeline
Patient Account Representative II
Stanford Health Care
12.2017 - Current
Insurance Follow Up Analyst
University Healthcare Alliance
08.2016 - 12.2017
Medical Assisting
Heald College
High School Diploma -
Ceres High School